Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2021; 9(11): 2446-2457
Published online Apr 16, 2021. doi: 10.12998/wjcc.v9.i11.2446
Early colonoscopy and urgent contrast enhanced computed tomography for colonic diverticular bleeding reduces risk of rebleeding
Masanori Ochi, Toshiro Kamoshida, Yukako Hamano, Atsushi Ohkawara, Haruka Ohkawara, Nobushige Kakinoki, Yuji Yamaguchi, Shinji Hirai, Akinori Yanaka
Masanori Ochi, Toshiro Kamoshida, Yukako Hamano, Atsushi Ohkawara, Haruka Ohkawara, Nobushige Kakinoki, Yuji Yamaguchi, Shinji Hirai, Department of Gastroenterology, Hitachi General Hospital, Ibaraki 317-0077, Japan
Akinori Yanaka, Hitachi Medical Education and Research Center, University of Tsukuba, Ibaraki 317-0077, Japan
Author contributions: Ochi M, Kamoshida T, Hamano Y, Ohkawara A, Ohkawara H, Kakinoki N, Yamaguchi Y, Hirai S and Yanaka A contributed equally to this work; Ochi M and Kamoshida T collected and analyzed the data; Ochi M drafted the manuscript; Kamoshida T designed and supervised the study; Hamano Y, Ohkawara A, Ohkawara H, Kakinoki N, Yamaguchi Y, Hirai S and Yanaka A offered technical or material support; all authors have read and approved the final version to be published.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Hitachi General Hospital (No. 2019-20). This study was registered with the University Hospital Medical Information Network (UMIN ID: 000037591).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at maochi-tei@umin.ac.jp.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Masanori Ochi, MD, Doctor, Department of Gastroenterology, Hitachi General Hospital, 2 Chome-1-1, Ibaraki 317-0077, Japan. maochi-tei@umin.ac.jp
Received: December 25, 2020
Peer-review started: December 25, 2020
First decision: January 17, 2021
Revised: January 25, 2021
Accepted: February 25, 2021
Article in press: February 25, 2021
Published online: April 16, 2021
Abstract
BACKGROUND

Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding (CDB) is recommended. However, little is known about rates of rebleeding within 30 d. We posited that a group of patients who underwent contrast-enhanced computed tomography (CT) within 4 h of the last hematochezia and colonoscopy within 24 h would experience fewer incidences of rebleeding.

AIM

To evaluate the outcomes of early colonoscopy for CDB among different groups of patients.

METHODS

Data from 182 patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018 at the study site were retrospectively reviewed. Patients were divided into groups based on the timing of the CT imaging, within or at 4 h were defined as urgent CTs (n = 100) and those performed after 4 h were defined as elective CTs (n = 82). Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage (SRH) (i.e., active bleeding, non-bleeding visible vessels, or adherent clots).

RESULTS

In total, 182 patients (126 men and 56 women) with median ages of 68.6 (range, 37-92) and 73.7 (range, 48-93) years, respectively, underwent CT imaging and colonoscopy within 24 h of the last hematochezia. Patients for whom CT was performed within 4 h of the last hematochezia were included in the urgent CT group (n = 100) and patients for whom CT was performed after 4 h were included in the elective CT group (n = 82). SRH were identified in 35.0% (35/100) of the urgent CT cases and 7.3% (6/82) of the elective CT cases (P < 0.01). Among all patients with extravasation-positive images on CT, SRH was identified in 31 out of 47 patients (66.0%) in the urgent CT group and 4 out of 20 patients (20.0%) in the elective CT group (P < 0.01). Furthermore, rates of rebleeding within 30 d were significantly improved in the urgent CT and extravasation-positive cases (P < 0.05). Results from the evaluation of early colonoscopy did not show a difference in the ability to detect SRH identification or rebleeding rates. Only cases by urgent CT reduced risk of rebleeding due to the evidence of active bleeding on the image.

CONCLUSION

To improve rates of rebleeding, colonoscopy is recommended within 24 h in patients with extravasation-positive CT images within 4 h of the last hema-tochezia. Otherwise, elective colonoscopy can be performed.

Keywords: Colonoscopy, Gastrointestinal hemorrhage, Colon, Diverticular diseases, X-ray computed tomography

Core Tip: While colonoscopy within 24 h of hospital admission for colonic diverticular bleeding (CDB) is recommended, there is no evidence of improved rates of rebleeding within 30 d. This study aimed to evaluate outcomes of early colonoscopy for CDB. Results indicate that rebleeding significantly improved in patients with extravasation-positive computed tomography images taken within 4 h of the last hematochezia (P < 0.05). Clinicians are advised to utilize contrast-enhanced computed tomography within 4 h of active CDB to detect extravasation-positive cases. For these patients, colonoscopy is recommended within 24 h to reduce the risk of rebleeding.